Ear wax

Ear wax, also called cerumen.

Known by the medical term cerumen, is a gray, orange, or yellowish waxy substance secreted in the ear canal of humans.

It protects the skin of the human ear canal, assists in cleaning and lubrication, and also provides protection against bacteria, fungi, insects, and water.

Consists of shed skin cells, hair, and the secretions of the ceruminous and sebaceous glands of the outside ear canal.

The primary components of earwax are: shed layers of skin, with, on average, 60% of the earwax consisting of keratin, 12–20% saturated and unsaturated long-chain fatty acids, alcohols, squalene and 6–9% cholesterol.

The movement of the jaw helps the ears’ natural cleaning process, and earwax removal is discouraged unless the excess earwax is causing problems.

In wet-type cerumen, these lipids include cholesterol, squalene, and many long-chain fatty acids and alcohols.

Cerumen has a bactericidal effect on some strains of bacteria, including Haemophilus influenzae, Staphylococcus aureus, and many variants of Escherichia coli.

Ear wax can sometimes reduce bacterial activity by as much as 99%.

Cerumen inhibits fungi associated with ear fungal infections.

The antimicrobial properties of ear wax are due to its saturated fatty acids, lysozyme and to the slight acidity of cerumen of about pH 6.1.

Despite its antimicrobial properties, it can support microbial growth with some cerumen samples having bacterial counts as high as 107/g cerumen.

Debris attached to the walls of the ear canal are discharged by jaw movement leading to its expulsion.

Cerumen prevents desiccation of the skin within the ear canal by providing lubrication.

The ear wax lubricative properties arise from the high lipid content of the sebum produced by the sebaceous glands.

The wet type earwax has a higher concentration of lipid and pigment granules; for example the wet type is 50% lipid while the dry type is only 20%.

The wax present inside the ear is made up of oil and sweat.

A mixture of viscous secretions from sebaceous glands and less-viscous ones from modified apocrine sweat glands.

Major components of earwax are long chain fatty acids, both saturated and unsaturated, alcohols, squalene, and cholesterol.

Cleaning of the ear canal occurs as a result of epithelial migration, aided by jaw movement.

Cells formed in the center of the tympanic membrane migrate outwards from the umbo to the walls of the ear canal, and move towards the entrance of the ear canal.

As cerumen in the ear canal is also carried outwardly it takes with particulate matter that may have gathered in the canal.

Excess or compacted cerumen can press against the eardrum or block the outside ear canal or hearing aids, potentially causing hearing loss.

It is produced in the outer third of the cartilaginous portion of the ear canal.

Ear wax types are genetically determined- the wet type, which is dominant, and the dry type, which is recessive.

East Asians and Native Americans are more likely to have the dry type of cerumen.

African and European people are more likely to have the wet type.

30-50% of South Asians, Central Asians and Pacific Islanders have the dry type of cerumen.

Cerumen type has been used by anthropologists to track human migratory patterns.

The difference in cerumen type has been tracked to a single base change, a single nucleotide polymorphism, in a gene known as ATP-binding cassette C11 gene.

The ABCC11 gene is also one the determining factors in wet or dry type earwax.

This gene determines whether people have wet or dry earwax.

Dry-type individuals are homozygous for adenine nucleobase whereas wet-type requires at least one guanine.

Wet-type earwax is associated with armpit odor, a manifestation of increased sweat production.

Old ear wax is moved through the ear canal by motions from chewing and other jaw movements and as the skin of the ear canal grows from the inside out.

Ear wax is produced in the outer part of the ear canal.

For most people, ears never need cleaning as they clean themselves.

Ear wax buildup and blockage may be precipitated when people use items cotton swabs or bobby pins to try to clean their ears pushing the ear wax farther into the ears.

It is generally advised not to use cotton swabs as it so will likely push the wax farther down the ear canal, and if used carelessly, perforate the eardrum.

Other complications as a result of attempting to remove ear wax include: otitis externa, as well as pain, vertigo, tinnitus, and perforation of the ear drum.


Ear wax impaction symptoms:

A feeling of fullness in the ear

Pain in the ear

Difficulty hearing

Ringing in the ear (tinnitus)

A feeling of itchiness in the ear

Discharge from the ear

Odor coming from the ear


Excessive earwax may impede the passage of sound in the ear canal, the result of which is conductive hearing loss.

Hearing aids may be associated with increased earwax impaction.

Earwax impaction from hearing aids is estimated to be the cause of 60–80% of hearing aid faults.

More common in those who use hearing aids or ear plugs, in those who put cotton swabs or other items into their ears, the elderly, in people with developmental disabilities, in people with ear canals shaped in such a way as to interfere with natural wax removal.

Diagnosis is by confirmation with an otoscope.

Methods to clean ear wax: Putting cerumenolytic solutions into the ear canal—these solutions include mineral oil, baby oil, glycerin, peroxide-based ear drops , hydrogen peroxide, and saline solution.

Softeners are generally effective, and are ref2242ed to as cerumenolytics.

There is not be much difference between types of softeners, including water and olive oil.

The most common method of cerumen removal if softeners is ineffective, is syringing with warm water.

Audiologists and otolaryngologists may use a curette when the ear canal is partially occluded.

Irrigating the ear by using a syringe to rinse out the ear canal with water or saline, generally after the wax has been softened or dissolved by a cerumenolytic.

The rate of major complications occurs in 1/1000 ears that are syringed.

Removing the wax manually using special instruments—such as a cerumen spoon, forceps, or suction device.

Earwax can be removed with an ear pick/curette, which physically dislodges the earwax and scoops it out of the ear canal.

A cerumenolytic should be used 2–3 times daily for 3–5 days prior to the cerumen extraction.

Cotton swabs push most of the earwax farther into the ear canal and remove only a small portion of the top layer of wax that happens to adhere to the fibers of the swab.

Irrigation should not be done if it is suspected the patient has a perforation in their eardrum or tubes in the affected ear(s).

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